Healthcare Provider Details

I. General information

NPI: 1386623916
Provider Name (Legal Business Name): JOSEPH WERRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MCHUGH BLVD 2ND DENTAL BATTALION/NAVAL DENTAL CENTER
CAMP LEJEUNE NC
28547-2511
US

IV. Provider business mailing address

315 MCHUGH BLVD 2ND DENTAL BATTALION/NAVAL DENTAL CENTER
CAMP LEJEUNE NC
28547-2511
US

V. Phone/Fax

Practice location:
  • Phone: 910-451-5705
  • Fax:
Mailing address:
  • Phone: 910-451-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4307
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: